Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

DCE: the dynamic conditional execution in a multipath control independent architecture

This thesis presents DCE, or Dynamic Conditional Execution, as an alternative to reduce the cost of mispredicted branches. The basic idea is to fetch all paths produced by a branch that obey certain restrictions regarding complexity and size. As a result, a smaller number of predictions is performed, and therefore, a lesser number of branches are mispredicted. DCE fetches through selected branches avoiding disruptions in the fetch flow when these branches are fetched. Both paths of selected branches are executed but only the correct path commits. In this thesis we propose an architecture to execute multiple paths of selected branches. Branches are selected based on the size and other conditions. Simple and complex branches can be dynamically predicated without requiring a special instruction set nor special compiler optimizations. Furthermore, a technique to reduce part of the overhead generated by the execution of multiple paths is proposed. The performance achieved reaches levels of up to 12% when comparing a Local predictor used in DCE against a Global predictor used in the reference machine. When both machines use a Local predictor, the speedup is increased by an average of 3-3.5%.

Divisão de poder e autoridade civil: governança, políticas públicas e desenvolvimento local em projetos fomentados por agências multilaterais

Dentro do atual contexto de crescente urbanização e novas oportunidades econômicas, a relação entre economia local e governo emerge como uma área estratégica para a promoção do desenvolvimento. No presente contexto de consolidação democrática e reforma do Estado, a responsabilização está associada à capacidade dos cidadãos em atuar na definição de metas coletivas e na criação de mecanismos institucionais que garantam o controle público da ação governamental e seus líderes, incrementando a governabilidade e, se não a eficiência, a eficácia de políticas públicas e seus processos de gestão. Esse trabalho pretende contribuir para o entendimento do papel dos órgãos de financiamento multilaterais em projetos de DEL, nomeadamente, para compreensão e a avaliação desses programas quanto ao resgate e aperfeiçoamento de bases de legitimidade social em ações de governo vinculadas à processos de desenvolvimento e promoção democrática. De modo específico, esse trabalho ambiciona compreender a concepção de grupos de interesse e sociedade civil presentes nos contratos fomentados pelo banco, assim como, a relevância conferida à esses agentes pelos técnicos do banco por ocasião da formulação desses contratos. Ao investigar esses pontos a pesquisa objetiva contribuir para o debate acerca dos dilemas e desafios para a implementação de programas de desenvolvimento urbano promovidos por governos locais em conjunto com organismos multilaterais.

O orçamento do governo local sob condições de participação dos cidadãos: o caso da Prefeitura de Santos

Este trabalho trata de um estudo de caso sobre a participação direta dos cidadãos no orçamento público municipal. Discute-se a teoria democrática sustentando-se que a democracia representativa apresenta fàlhas que exigem mecanismos corretivos e que a participação direta dos cidadãos se apresenta como uma alternativa para corrigir esses desvios. A premissa básica que permeia toda a pesquisa é a da participação direta como meio eficiente de controle do cidadão sobre as ações do Estado - Governo Local. Por meio da análise do Programa de Governo do Partido e do Plano de Governo da Prefeitura de Santos~ procurou-se verificar quais os fundamentos teóricos da participação direta que orientam as ações do Governo Municipal Santista. A dimensão institucional da participação é explorada por meio da descrição e análise crítica das formas de participação direta~ previstas na legislação constitucional - Constituições Federal e Estadual de São Paulo e Lei Orgânica do Município de Santos. Busca-se identificar quais são os limites dos mecanismos de participação direta, previstos na legislação. quando aplicados ao orçamento municipal. A investigação sobre o processo decisório orçamentário visa a captar qual lógica subjaz no processo de alocação de recursos no orçamento público. Embora se tenha assinalados certos embaraços jurídicos e operacionais à participação direta dos cidadãos no orçamento~ esses entraves não invalidam a importância da experiência com orçamento participativo no Município de Santos. A proposta da Prefeitura Santista, por seu caráter inovador e educativo revela-se uma valiosa contribuição para a prática de uma gestão mais democrática e transparente no âmbito municipal.

Diagnóstico, monitoramento e controle social na agenda governamental local no Brasil: o caso das leis municipais que determinam a adoção de programas de metas

Este texto busca descrever e analisar, ainda muito incipientemente, de que forma o tema do monitoramento, a partir de indicadores sociais, e do controle social da gestão pública local por meio do estabelecimento de Planos de Metas para a gestão pública entra na agenda pública de muitos municípios brasileiros a partir de 2008. Buscar-se-á, também, analisar de que forma os Planos de Metas apresentam oportunidades e desafios que podem alterar a cultura de gestão nesses municípios, principalmente por parte do poder executivo, no que diz respeito à adoção de um diagnóstico municipal que efetivamente oriente a tomada de decisão e a formulação de políticas públicas no âmbito local. Palavras-chave: programas de metas, gestão local, planejamento, monitoramento, indicadores 

Micro and nanosystems for delivering local anesthetics

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Stability and Local Toxicity Evaluation of a Liposomal Prilocaine Formulation

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Ação local do alendronato sódico na reparação óssea de ratos espontaneamente hipertensos (SHR)

FUNDAMENTO: A hipertensão arterial é uma desordem caracterizada por alterações relevantes no tecido ósseo. O alendronato sódico tem indicação no tratamento de doenças ósseas, por causa de sua afinidade pela hidroxiapatita, inibindo as reabsorções ósseas. OBJETIVO: Analisar a ação local do alendronato sódico na reparação óssea de ratos espontaneamente hipertensos (SHR). MÉTODOS: Um defeito ósseo foi criado no fêmur esquerdo de 80 ratos. de acordo com o material utilizado no local, criaram-se quatro grupos: controle (C), amido (Am), alendronato 1 mol (A1) e alendronato 2 mol (A2). Após 7 e 21 dias, os animais foram sacrificados. Foram realizadas análises histológicas e histomorfométricas e os dados foram submetidos a análise de variância (ANOVA) e teste de Tukey (5%). RESULTADOS: Aos 7 dias, observou-se, na área do defeito, tecido conjuntivo com hemorragia e inflamação em todos os grupos. Alguns apresentavam matriz osteóide. Os grupos A1 e A2 apresentaram, ainda, uma rede de fibrina. Aos 21 dias, as trabéculas ósseas fechavam praticamente a extensão do defeito nos grupos C e Am. No grupo A1 de animais machos, observaram-se trabéculas que se irradiavam do canal medular até a área do defeito. Nos grupos A1 e A2, constatou-se apenas a presença de tecido conjuntivo com mínima deposição de osteóide. Um achado histológico marcante foi a formação de tecido ósseo extracortical subperiosteal nos animais dos grupos A1 e A2. CONCLUSÃO: Concluiu-se que a administração do alendronato sódico não contribuiu para o reparo ósseo nos ratos SHR, mas possivelmente tenha sido responsável pelas formações ósseas extracorticais observadas.

As condições e o sentido do trabalho doméstico realizado por adolescentes que residem no local de emprego

The house work is a reality for girls of humble class and one of the most found forms of work among adolescent workers. Moreover, it is a mean of work which reproduces poverty and gender relations within the society. The purpose of this essay in to understand the house work in the life of adolescent workers, emphasizing the meaning produced by these teenagers concerning the job they perform. In order to achieve such goal, questionnaires were applied to 332 adolescents, under 18 years old from public schools (from EJA-supletivo) in Natal, with the purpose of mapping the registration of this activity among young students. Next, 14 adolescents were interviewed in order to recognize the meaning of this work and its repercussions over the teenagery, such as school education, socialization, relations with employers and adolescent s self-image. Later we have noticed most workers among the students from public schools are housemaids. Furthermore, this work is used as a form of social ascension and it contributes for the search for better opportunities in the state capital for adolescents who leave the countryside trying to agree to education and remuneration. This work plays an important role, which is to reproduce gender relations, as a woman works to maintain the private space as a female space and maintains the man out of this relation. Besides it reproduces class relations, ethny and generation conflicts, in which the employer replaces the control the parents have in the adolescent s life. Summing up, this study about house work have negative aspects, related to exploitation, humiliation and mistreat, as well as positive ones, for it permits the adolescent to improve his life conditions. The most important thing is to look for a mean of work in which human and workers rights are respected

Reactive Control for Transmission Overload Relief Based on Sensitivity Analysis and Cooperative Game Theory

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Treatment of Endometriosis with Local Acetylsalicylic Acid Injection: Experimental Study in Rabbits

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Corrective eyeglasses and medial canthal basal cell carcinoma: a case-control study

Background Corrective eyeglasses are frequently worn by adults, particularly at older ages. Their lenses and frames provide ultraviolet protection. Medial canthal basal cell carcinomas are infrequent (38%), and their relation with the use of corrective glasses was not yet investigated. Objectives To assess the prevalence of corrective eyeglasses use in individuals with medial canthal basal cell carcinoma. Methods Case-control study using two controls matched by age, gender, and ethnicity for each case. Cases were patients with medial canthal basal cell carcinoma, and controls were patients with basal cell carcinoma elsewhere on the face. The prevalence of major risk variables was estimated and adjusted by conditional multiple logistic regression. Results Fifty cases and 100 controls were assessed. The mean patient age was 69.7 years, and 54% of the subjects were females. No difference regarding the eyeglasses use or use duration was found between groups. However, when visual defects were separately evaluated, eyeglasses for myopia correction were independently associated with lower risk of medial canthal basal cell carcinoma development (OR = 0.26; P = 0.03), what can be related to long term local photoprotection. Conclusion The use of eyeglasses for myopia correction is associated with lower prevalence of medial cantal basal cell carcinoma. Risk-reducing mechanisms should be elucidated.

Local application of tetracycline solution with a microbrush: An alternative treatment for persistent periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)